History

A detailed history, including the duration of the disease, characteristics and frequency of bowel movements, and associated abdominal and systemic symptoms, may provide a clue to the underlying cause. The presence of a common source, types of specific food, travel history, and use of antibiotics always should be investigated.

The presenting complaints, typical features and pathogenesis of various causative agents, and diagnosis and treatment information can be found in Table 1 in the Causes section.

The following are some of the salient features of food poisoning:

Acute diarrhea in food poisoning usually lasts less than 2 weeks. Diarrhea lasting 2-4 weeks is classified as persistent. Chronic diarrhea is defined by duration of more than 4 weeks.

The presence of fever suggests an invasive disease. However, sometimes fever and diarrhea may result from infection outside the GI tract, as in malaria.

A stool with blood or mucus indicates invasion of the intestinal or colonic mucosa.

When vomiting is the major presenting symptom, suspect
Staphylococcus aureus, B cereus, or
Norovirus.
[1]

Reactive arthritis can be seen with
Salmonella, Shigella, Campylobacter, and
Yersinia infections.

A rectal examination always should be performed to directly visualize the stool, to test occult blood, and to palpate the rectal mucosa for any lesions.

Rose spot macules on the upper abdomen and hepatosplenomegaly may be seen in
Salmonella typhi infection.

Erythema nodosum and exudative pharyngitis are suggestive of
Yersinia infection.

Patients with
Vibrio vulnificus or
Vibrio alginolyticus may present with cellulitis and otitis media.

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Causes

The CDC estimates that 97% of all cases of food poisoning result from improper food handling; 79% of cases result from food prepared in commercial or institutional establishments and 21% of cases result from food prepared at home.
[7]

The most common causes are as follows: (1) leaving prepared food at temperatures that allow bacterial growth, (2) inadequate cooking or reheating, (3) cross-contamination, and (4) infection in food handlers. Cross-contamination may occur when raw contaminated food comes in contact with other foods, especially cooked foods, through direct contact or indirect contact on food preparation surfaces.

Bacteria are responsible for approximately 75% of the outbreaks of food poisoning and for 80% of the cases with a known cause in the United States.
[5] As many as 1 in 10 Americans has diarrhea due to food-borne infection each year.

Other symptoms include paresthesia of the extremities, headache, ataxia, vertigo, cranial nerve palsies, and paralysis of respiratory muscles, resulting in respiratory arrest

Fish acquires toxin-producing dinoflagellates

General observation for 4-6 h

Maintain patent airway.

Administer oxygen, and assist ventilation if necessary

For recent ingestion, charcoal 50-60 g may be helpful

Neurotoxic shellfish poisoning

Coastal Florida

Source - Mollusks

Illness is milder than in paralytic shellfish poisoning

Fish acquires toxin-producing dinoflagellates

Symptomatic

Ciguatera

Hawaii, Florida, and Caribbean

Source - Carnivorous reef fish

Vomiting, diarrhea, and cramps start 1-6 h after ingestion and last from days to months

Diarrhea may be accompanied by a variety of neurologic symptoms including paresthesia, reversal of hot and cold sensation, vertigo, headache, and autonomic disturbances such as hypotension and bradycardia

Chronic symptoms (eg, fatigue, headache) may be aggravated by caffeine or alcohol

Onset of symptoms usually is 30-40 min but may be as short as 10 min; it includes lethargy, paresthesia, emesis, ataxia, weakness, and dysphagia; ascending paralysis occurs in severe cases; mortality is high.

Neurotoxin is concentrated in the skin and viscera of puffer fish.

Symptomatic

Scombroid

Source - Tuna, mahi-mahi, kingfish

Allergic symptoms such as skin flush, urticaria, bronchospasm, and hypotension usually start within 15-90 min

Improper preservation of large fish results in bacterial degradation of histidine to histamine

Other symptoms include paresthesia of the extremities, headache, ataxia, vertigo, cranial nerve palsies, and paralysis of respiratory muscles, resulting in respiratory arrest

Fish acquires toxin-producing dinoflagellates

General observation for 4-6 h

Maintain patent airway.

Administer oxygen, and assist ventilation if necessary

For recent ingestion, charcoal 50-60 g may be helpful

Neurotoxic shellfish poisoning

Coastal Florida

Source - Mollusks

Illness is milder than in paralytic shellfish poisoning

Fish acquires toxin-producing dinoflagellates

Symptomatic

Ciguatera

Hawaii, Florida, and Caribbean

Source - Carnivorous reef fish

Vomiting, diarrhea, and cramps start 1-6 h after ingestion and last from days to months

Diarrhea may be accompanied by a variety of neurologic symptoms including paresthesia, reversal of hot and cold sensation, vertigo, headache, and autonomic disturbances such as hypotension and bradycardia

Chronic symptoms (eg, fatigue, headache) may be aggravated by caffeine or alcohol

Onset of symptoms usually is 30-40 min but may be as short as 10 min; it includes lethargy, paresthesia, emesis, ataxia, weakness, and dysphagia; ascending paralysis occurs in severe cases; mortality is high.

Neurotoxin is concentrated in the skin and viscera of puffer fish.

Symptomatic

Scombroid

Source - Tuna, mahi-mahi, kingfish

Allergic symptoms such as skin flush, urticaria, bronchospasm, and hypotension usually start within 15-90 min

Improper preservation of large fish results in bacterial degradation of histidine to histamine